Liebeskind Amy, Sikora Andrew G, Komisar Arnold, Slavit David, Fried Karen
Department of Radiology, Lenox Hill Hospital, 100 E 77th St, New York, NY 10021, USA.
J Ultrasound Med. 2005 May;24(5):629-34. doi: 10.7863/jum.2005.24.5.629.
The purpose of this study was to compare the rate of malignancy in thyroid nodules discovered incidentally on magnetic resonance imaging, computed tomography, and sonography with the rate of malignancy in nonincidentally discovered nodules.
All thyroid sonographic and fine-needle aspiration (FNA) procedures performed during a 6-month period were retrospectively reviewed. Study indications were categorized as incidental (thyroid nodules found on magnetic resonance imaging, computed tomography, or sonography performed for nonthyroid indications) or nonincidental (studies prompted by abnormal physical examination findings or laboratory values or signs or symptoms suggestive of thyroid disease). Rates of malignancy in patients with incidentally discovered nodules were compared with rates in patients with nonincidental thyroid abnormalities by the Fisher exact test.
Of 225 thyroid sonographic studies, 35 (16%) were performed for incidentally discovered thyroid nodules, and 190 (84%) were performed for evaluation of nonincidental thyroid abnormalities. A total of 21 patients (60%) in the incidental group and 90 patients (47%) in the nonincidental group underwent FNA. The rate of malignancy in nodules examined by biopsy in the incidental group was 17% compared with 3% in the nonincidental group (P = .020). Patient sex, multiplicity of nodules, nodule size, echo texture, and presence of calcifications did not differ significantly between the groups. The mean age of patients in the incidental group was significantly higher (61 versus 51 years; P = .007); however, advanced age was not associated with a greater rate of malignancy.
This study identified an unexpectedly high rate of malignancy in incidentally discovered thyroid nodules, suggesting that incidentally discovered thyroid nodules should be evaluated with follow-up thyroid sonography and FNA.
本研究旨在比较磁共振成像、计算机断层扫描及超声检查偶然发现的甲状腺结节的恶性率与非偶然发现结节的恶性率。
回顾性分析6个月期间所有甲状腺超声检查及细针穿刺抽吸（FNA）操作。研究指征分为偶然（因非甲状腺指征行磁共振成像、计算机断层扫描或超声检查时发现的甲状腺结节）或非偶然（由体格检查异常结果、实验室检查值或提示甲状腺疾病的体征或症状引发的检查）。通过Fisher精确检验比较偶然发现结节患者与非偶然甲状腺异常患者的恶性率。
在225例甲状腺超声检查中，35例（16%）是针对偶然发现的甲状腺结节进行的，190例（84%）是用于评估非偶然甲状腺异常。偶然组共有21例患者（60%）接受了FNA，非偶然组有90例患者（47%）接受了FNA。偶然组活检检查的结节恶性率为17%，而非偶然组为3%（P = 0.020）。两组患者的性别、结节的多发性、结节大小、回声质地及钙化情况无显著差异。偶然组患者的平均年龄显著更高（61岁对51岁；P = 0.007）；然而，高龄与更高的恶性率无关。
本研究发现偶然发现的甲状腺结节恶性率出乎意料地高，提示偶然发现的甲状腺结节应通过后续甲状腺超声检查及FNA进行评估。
